Good drug supply management is an essential component of effective health care system. This study investigated the relationship of dependent and independent influential attributes towards overall patient satisfaction in addition to its impact on the quality improvement process of healthcare organizations. Subjects and methods: Face-to-face interviews with doctors about patients’ satisfaction (80 doctors and 800 patients) were the main research method and the population of the study was 800 patients in 8 general hospitals. Tables and graphs were used to represent data. Results: The overall satisfaction score with the medicine management in national health insurance was 3.7. This study found that most patients were satisfied with drug supply in the insurance list (95.33% for satisfaction). The highest satisfaction belonged to the cost of drug (97.05%). It showed that patients older than 50 years of age had higher satisfaction than patients under 18 years of age and gender was not a significant predictor of overall patient satisfaction. Conclusions: This research provides the background for organization managers and policy makers to yield a better understanding of patients’ opinions and the extent of their involvement in improving the quality of care and services.
Journal of military pharmaco-medicine n02-2019 ASSESSMENT OF MEDICINE MANAGEMENT AND ITS SUPPLY IN NATIONAL HEALTH INSURANCE AT GENERAL HOSPITALS IN CANTHO CITY IN THE PERIOD OF 2016 - 2017 Nguyen Phuc Hung1; Pham Thanh Trong2; Phan Phong Trieu1 SUMMARY Objectives: Good drug supply management is an essential component of effective health care system This study investigated the relationship of dependent and independent influential attributes towards overall patient satisfaction in addition to its impact on the quality improvement process of healthcare organizations Subjects and methods: Face-to-face interviews with doctors about patients’ satisfaction (80 doctors and 800 patients) were the main research method and the population of the study was 800 patients in general hospitals Tables and graphs were used to represent data Results: The overall satisfaction score with the medicine management in national health insurance was 3.7 This study found that most patients were satisfied with drug supply in the insurance list (95.33% for satisfaction) The highest satisfaction belonged to the cost of drug (97.05%) It showed that patients older than 50 years of age had higher satisfaction than patients under 18 years of age and gender was not a significant predictor of overall patient satisfaction Conclusions: This research provides the background for organization managers and policy makers to yield a better understanding of patients’ opinions and the extent of their involvement in improving the quality of care and services * Keywords: Patient satisfaction; Drug management; Drug supply; Quality for healthcare INTRODUCTION The issue of media in the health sector in recent years has been "Enhancing the quality of medical examination and treatment of basic health insurance" The goal of the strategy was to advance the quality of basic health services, patients satisfaction as well as favorable conditions for people to receive the best, fastest and most convenient health care, reducing unnecessary fees, practice thrift, concentration investment resources, effective use Patients' participation in their management, care and treatment is an indispensable trend in the modern health system, which is being done in current health strategies in many countries around the world Cantho University of Medicine and Pharmacy Tay Do University Corresponding author: Nguyen Phuc Hung (nphung@ctump.edu.vn) Date received: 20/12/2018 Date accepted: 18/01/2019 119 Journal of military pharmaco-medicine n02-2019 In order to improve the quality of drug supply management, various interventions have been used to influence the stages of drug supply and management in hospitals such as education knowledge improvement, management and application computer [7] In 2008, a study by Mubondwa et al at Muhimbili International Hospital in Tanzania on 2,582 patients (inpatients and outpatients) showed that most patients were satisfied with the medical services which they received The most dissatisfying factor was the attitudes of health staff Anna Maria Murante's PhD thesis in 2010 focused on the role of patient satisfaction in the management of health services This study was primarily concerned with surveys, patient experiences and patient satisfaction that had been conducted in Tuscany region [6] In Vietnam, Tran Vien surveyed drug management at Pharmacy Department, General Hospital at Tinhbien district in 2012 The results of survey in the management of the department showed that the satisfaction accounted for over four fifth of the total, at 84% as opposed to 16% of counterparts due to complex procedures, wait a long time, need to improve the process of health insurance drug distribution [5] A survey on the satisfaction of inpatients at Namdong Hospital, Hue in 2012, resulted in the convenience of simple administrative procedures and the timeless of the patient, with 84.3% and 15.7% for satisfaction and dissatisfaction respectively, and 98.21% were satisfied with the treatment and care of health staff In Nguyen Tuyen's 2012 120 study at Tay Nguyen University Hospital, patient satisfaction with waiting times at this hospital was 3.5/5 [4] Cantho, a central city in Mekong Delta region, to the best of our knowledge, there is no comprehensive evaluation of the system of supplying health insurance at the basic level Therefore, we conducted this study to investigate the problems in eight local hospitals, across rural areas of Cantho city Our main goal is: To evaluate patient satisfaction factors and the quality of drug supply at health facilities SUBJECTS AND METHODS Subjects The study was conducted in district hospitals, namely: O Mon, Cai Rang, Thot Not, Phong Dien, Thoi Lai, Vinh Thanh, Co Do and Binh Thuy from September 2016 to June 2017 Research subjects were doctors who directly examined, treated the disease and outpatients who visited health facilities in the research period * Exclusive criteria: Health facilities, patients who didn’t agree with participating in this research and answering all of the questions on the questionnaires or patients move into boarding Methods Using cross-sectional descriptive study, the sample size was 80 doctors and 800 patients that were interviewed equally during the study health facilities [8] Each sample was analyzed based on two groups of parameters, as followed: Journal of military pharmaco-medicine n02-2019 - Survey on management situation: To carry out an assessment of pharmacy personnel, pharmacy infrastructure, the distribution capacity, the list of drugs, the timeliness in supply and the clinical pharmacology through the sociological questionnaire for doctors - Survey on supply situation: To conduct a survey on indicators for providing health insurance: transportation convenience, cost, time, facilities and staff attitude through sociological questionnaire for patients The scale of the patient's satisfaction with the quality of health care was based on the Likert Score scale with "very dissatisfied" (1 point), "dissatisfied" (2 points), "normal" (3 points), "satisfied" (4 points), "very satisfied" (5 points) [10] For ethical issues, all processes were approved by Cantho University of Medicine and Pharmacy (CTUMP) and Medicine Ethics Committee/Ethical Committee on Pharmaceuticals, as well as the Director of hospital RESULTS Physician’s satisfaction about medicine management of National Health Insurance * Medical management indicators of National Health Insurance: The satisfaction rate with medicine management at hospitals through the evaluation of 80 doctors at local hospital was 3.72 The highest satisfaction level were about aspects of pharmacy personnel and infrastructure with a mean value of 4.02 and 4.12; followed by the distribution capacity, list of drugs, timely delivery, clinical pharmacology with corresponding values of 3.94, 3.38, 3.71, 3.19, respectively Patient satisfaction with drug supply of the National Health Insurance Table 1: Calculation of level of satisfaction in terms of different domains of patient satisfaction with drug supply of the National Health Insurance Result (n = 800) Domain of satisfaction Mean Percentage (%) Transportation convenient 4.11 95.0 Medication costs 3.85 97.5 Time spent for drug supply 3.91 95.4 Drugs distribution 4.10 95.3 Attitudes and guidance of staff 4.07 95.3 3.99 ± 0.02 95.5 Overall satisfaction The average satisfaction index of 800 patients was 4.0 and 95.5% satisfied with the drug distribution The highest satisfaction of patient was medicine costs (97.5%), followed by transportation convenience, time spent for drug supply, drugs distribution, attitudes and guidance of staff (approximately 95.0%) 121 Journal of military pharmaco-medicine n02-2019 Relation of overall satisfaction with variables Table 2: Distribution of study population according to age groups of patient satisfaction Age groups Disatisfaction Satisfaction OR; 95%CI p < 18 (1.2%) 86 (98.9%) - - 18 - 29 (10.8%) 33 (89.2%) 1.922 (0.21 - 17.45) 0.562 30 - 49 (2.2%) 179 (97.8%) 0.386 (0.13 - 1.12) 0.079 ≥ 50 27 (3.5%) 466 (96.5%) 0.184 (0.044 - 0.774) 0.021 Total 36 (4.5%) 764 (95.5%) Logistic regression analysis between the overall satisfaction and age of patients The patients older than 50 years old had disatisfaction rate less than 0.184 times compared to patients under 18 years of age, which was statistically significant at p < 0.05 The satisfaction rate among the remaining age groups and the under 18 age group was not statistically significant with p > 0.05 Table 3: Distribution of study population according to gender in terms of patient satisfaction Gender Disatisfaction Satisfaction Male 16 (4.7%) 327 (95.3%) Female 20 (4.4%) 457 (95.6%) Total 36 (4.5%) 764 (95.5%) OR; 95%CI 1.069 (0.546 - 2.095) p 0.846 In another case, gender and patient satisfaction were not correlated (p = 0.846 > 0.05) DISCUSSIONS Physician’s satisfaction with medicine management of National Health Insurance According to the report by Agency of Health Examination and Treatment, Ministry of Health in 2015, the pharmacy personnel reached 2.5 pharmacists per 10,000 population and has been on the increase in recent years [1] This showed the attention of organization managers to human resource development and facilities The drug distribution, the list of drugs, timely delivery, clinical pharmacology were lower satisfaction factors with increasing 122 scores of 3.19 to 3.94 Besides, time for drug delivery was too long Doctors thought that medical supply ability was not as good as their aspect, the clinical pharmacy activity was mainly medical information and rational medicine use The results of the interview on physicians satisfaction showed a mean score of 3.71, lower than the “satisfied” level (4.0) Hospitals should review the results of their application in practice, continue to develop good points from experience and propose the solution to the improvement in the services and strategic goals for all healthcare organizations Journal of military pharmaco-medicine n02-2019 Patient’s satisfaction about the drug supply of National Health Insurance Results showed the overall satisfaction scores ranged from 3.85 to 4.11, with a mean score of 3.99 and 95.5% for satisfaction The overall satisfaction rate of the patients in Tran Thanh Thang's study at Hatinh General Hospital was 90.98%, lower than in our study (95.5%) [3] The satisfaction rate was 97.5% higher than that in Truong Thi Thanh Quy’s study at Hanoi Medical University Hospital (94.9%) [2] Patients were highly satisfied with medication costs because the National Health Insurance system supports them the cost of medical examination and treatment The results were similar to Mubondwa et al’s findings (2008) at Muhimbili International Hospital in Tanzania on 2,582 patients They were particularly dissatisfied with the high costs of treatment and investigations charged and negative attitudes of staff towards patients [7] Relationship of overall satisfaction with variables Many medical literatures pointed out the relationship between demographic factors such as age, gender, health status and level of education with patient satisfaction The results showed that patients aged ≥ 50 had a lower dissatisfaction rate of 0.184 times than patients under 18 years of age but gender was not a significant predictor of overall patient satisfaction (p < 0.05) The rate of satisfaction was 95.3% for women and 95.6% for men This difference was not statistically significant with p = 0.85 This study was similar to Tonio Schoenfelde’s research in 2011 on 39 health centers in Germany, patients’ age was related to level of satisfaction (p < 0.001) and Nguyen Manh Tuyen in Hospital University of Tay Nguyen in 2012: the female’s satisfaction rate was lower than male’s, this difference was not statistically significant with p > 0.05 [4, 9] The high satisfaction rate was likely that the older were served more carefully than the younger CONCLUSIONS This study investigated the drug management and supplement in National Health Insurance and identified determinants of physician and patient satisfaction Findings were based on data collected from a large number of patients in district hospitals The level of satisfied patients was different in age, while gender was not related to satisfaction Variables provide implications for health providers aiming at improving the service quality and quality of care: standardizing the management and delivery drug for patients; publishing and updating drug information, treatment costs; improving facilities REFERENCES Ministry of Health of Vietnam Joint Annual Health Review 2015: Improving the skills of primary health care teams working at the grass-roots level Hanoi Medical Publishing House 2016, June, pp.36-37 Truong Thi Thanh Quy Patient satisfaction with the quality of medical services at the Department of Obstetrics and Gynecology Hanoi Medical University Hospital in 2017 and influencing factors Hanoi Medical University 2017 123 Journal of military pharmaco-medicine n02-2019 Pham Luong Son Reality of bidding for health insurance contracts at public health centers in Vietnam Hanoi University of Pharmacy 2012 Nguyen Manh Tuyen Patient satisfaction at Tay Nguyen University Hospital The faculty of Pharmacy Tay Nguyen University, Buon Ma Thuot 2012 Tran Tan Vien Monitoring the supply and management of health insurance at Tinhbien General Hospital in Angiang province Hochiminh City University of Medicine and Pharmacy 2012 Anna Maria Murante Patient satisfaction a strategic tool for health services management Thesis to the Class of Social Sciences for the degree of Doctor of Philosophy Di Studi Universitari e di Perfezionamento 2010 124 E.P.Y.Muhondwa, Leshabari M.T, Mwang M, Mbembati N, Ezekiel M.J Patient satisfaction at the Muhimbili National Hospital in Tanzania East African Journal of Public Health 2008, (2), pp.67-73 Kathleen Holloway Drug and Therapeutics committees: A practical guide Geneva World Health Organization 2003 Tonio Schoenfelder, Joerg, Klewer, Joachim Kugler Determinants of patient satisfaction: a study among 39 hospitals in an in-patient setting in Germany International Journal for Quality in Health Care 2011, Volume 23, Issue 5, October, pp.503-509 10 WHO Strategic plan for strengthening health system in the WHO Western Pacific Region World Health Organization 2008 Western Paific Region, Manila ... about medicine management of National Health Insurance * Medical management indicators of National Health Insurance: The satisfaction rate with medicine management at hospitals through the evaluation... Table 1: Calculation of level of satisfaction in terms of different domains of patient satisfaction with drug supply of the National Health Insurance Result (n = 800) Domain of satisfaction Mean... evaluation of the system of supplying health insurance at the basic level Therefore, we conducted this study to investigate the problems in eight local hospitals, across rural areas of Cantho city